Who Performs Mitral Valve Repair
| Mitral valve repair | |
|---|---|
 Anterior (frontal) view of the opened heart. White arrows indicate normal blood catamenia. (Mitral valve labeled at middle right.) | |
| ICD-9-CM | 35.12 |
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to care for stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the heart. After the left atrium fills with blood, the mitral valve allows blood to flow from the left atrium into the heart's main pumping bedchamber called the left ventricle. It then closes to keep blood from leaking back into the left atrium or lungs when the ventricle contracts (squeezes) to push blood out to the body. Information technology has two flaps, or leaflets, known every bit cusps.
The techniques of mitral valve repair include inserting a cloth-covered band effectually the valve to bring the leaflets into contact with each other (annuloplasty), removal of redundant/loose segments of the leaflets (quadrangular resection), and re-pause of the leaflets with bogus (Gore-Tex) cords.
Procedures on the mitral valve normally require a median sternotomy, but advances in non-invasive methods (such as keyhole surgery) allow surgery without a sternotomy (and resulting pain and scar). Minimally invasive mitral valve surgery is much more technically enervating and may involve higher chance.
Occasionally, the mitral valve is aberrant from nascency (congenital). More than often the mitral valve becomes abnormal with age (degenerative) or as a event of rheumatic fever. In rare instances the mitral valve tin can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease) or not-ischemic middle disease (dilated cardiomyopathy).
History [edit]
In 1923 Dr. Elliott Cutler of the Peter Bent Brigham Hospital performed the world's showtime successful heart valve surgery – a mitral valve repair. The patient was a 12-year-quondam girl with rheumatic mitral stenosis.[ citation needed ]
The development of the middle-lung machine in the 1950s paved the mode for replacement of the mitral valve with an bogus valve in the 1960s. For decades after, mitral valve replacement was the but surgical option for patients with a severely diseased mitral valve. However, there are some pregnant downsides to a prosthetic mitral valve. Infection of the valve can occur, which is dangerous and hard to treat. Patients with mechanical heart valves are required to take blood thinners for the rest of their lives, which presents a gamble of bleeding complications. The artificial mitral valve has an elevated chance of stroke. Patients with mechanical centre valves who use warfarin for anticoagulation have to exist on long-term anticoagulation therapy. This means they must go to the clinic and have a lab blood draw done, typically one time a calendar month but more frequently if the level needs to be closely monitored until it is in the therapeutic range. The therapeutic range for nearly adults with a mechanical valve is an INR of 2.5–3.5.[1] Finally, bogus tissue valves volition wear out – on average lasting between 10 and 15 years, requiring further surgery at an avant-garde age.
In the by ii decades, some surgeons take embraced surgical techniques to repair the damaged native valve, rather than replace it. These techniques were pioneered by a French middle surgeon, Dr. Alain F. Carpentier. A repair still involves major cardiac surgery but for many patients presents the significant advantage of avoiding blood thinners and may provide a more durable result. Not all damaged valves are suitable for repair; in some, the state of valve illness is too advanced and replacement is necessary. Often, a surgeon must determine during the performance itself whether a repair or a replacement is the best grade of action. For patients with the about common blazon of mitral valve disease, termed "degenerative" or "myxomatous" mitral valve affliction, repair rates are very high and long term durability is splendid.[2]
There has been keen contend well-nigh timing of surgery in patients with asymptomatic mitral valve regurgitation.
The traditional surgical approach to a mitral valve repair is a full or partial sternotomy, in which the surgeon cuts through the breastbone at the center of the chest to access the heart. There are minimally invasive (port access) options bachelor pioneered by Hugo Vanerman in Kingdom of belgium. The minimally invasive approach does not involve cutting the breastbone, but instead uses multiple incisions in the side of the chest and the leg. Cardiac surgeons are non unanimous about the relative merits of sternotomy versus the minimally invasive approach. The minimally invasive approach tin produce a less prominent scar, is benign for very obese patients, and may let the patient to return to their normal activity sooner than a sternotomy. Just some cardiac surgeons argue that unless performed by the most experienced cardiac centers, minimally invasive surgery tin can involve a longer fourth dimension on a bypass automobile, a lower repair rate, and higher (although still low) risk of stroke. I cardiac surgery professor said, "I call up the only benefit is for cosmesis for the patient and the benefit is for marketing and growing our practices for ourselves considering information technology'southward a skillful way to abound one'due south practice."[three]
Robotic mitral valve repair operations are also being utilized throughout the U.s..
In the 2000s in that location have been several trials of a newer strategy of mitral valve repair that does not crave major cardiac surgery. Through a catheter inserted in the groin, the valve leaflets are clipped together. This technique – percutaneous mitral valve repair – is available in Europe but still in clinical trial in the United States. It is a highly specialized technique only bachelor at select hospitals. Early trial results suggest that it may be a beneficial approach for patients who are at loftier gamble from conventional surgery.[iv] [v]
Every bit early every bit January 2000 a team of doctors[6] at the Instituto de Cardiología y Cirugía Cardiovascular in La Habana, Cuba have performed beating heart mitral valve repair or replacement. The chirapsia heart mitral valve replacement technique is as safe equally the arrested heart technique, and is the recommended alternative to arrested heart technique.[7]
See also [edit]
- Aortic valve repair
- Cardiac surgery
- Mitral valve insufficiency
- MitraClip
References [edit]
- ^ Lewis, Sharon (2015). Medical-Surgical Nursing: Assessment and Direction of Clinical Problems (Ninth ed.). St. Louis, MO: Elsevier Mosby. p. 825. ISBN978-0323086783.
- ^ Johnston, Douglas R.; Gillinov, A. Marc; Blackstone, Eugene H.; Griffin, Brian; Stewart, William; Sabik, Joseph F.; Mihaljevic, Tomislav; Svensson, Lars Thou.; Houghtaling, Penny L.; Lytle, Bruce West. (2010). "Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair". The Register of Thoracic Surgery. 89 (5): 1385–94. doi:x.1016/j.athoracsur.2009.12.070. PMID 20417750.
- ^ http://www.mitralvalverepair.org/content/view/260/ Ani Anyanwu, Mt. Sinai Medical Center, "'Minimally Invasive Surgery' - Facts", MitralValveRepair.org, October 13, 2022. Retrieved 17 August 2022.
- ^ Mitral Valve Prolapse, Functional MR, Cardiac Surgery, Degenerative MR, and Cardiomyopathy - Evalve, Inc Archived June 8, 2007, at the Wayback Machine
- ^ Phend, Crystal (22 May 2022). "HFC: Mitral Valve Prune Viable When Surgery Too Risky". MedPageToday. Retrieved 17 August 2022.
- ^ Guillermo Mojena Morfa; Julio Taín Blázquez; Ángel M. Paredes Cordero; Horacio Pérez López; Lisbeth González González
- ^ "Efficacy and Safety of Beating Centre Mitral Valve Replacement". Archived from the original on 2022-03-04. Retrieved 2016-01-06 .
Further reading [edit]
- Wong, R. H.; Lee, A. P.; Ng, C. S.; Wan, I. Y.; Wan, S.; Underwood, Grand. J. (2010). "Mitral Valve Repair: Past, Present, and Future". Asian Cardiovascular and Thoracic Annals. eighteen (6): 586–95. doi:x.1177/0218492310383916. PMID 21149413.
Source: https://en.wikipedia.org/wiki/Mitral_valve_repair
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